Emergency in the Practice of Family Doctor
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MINISTRY OF PUBLIC HEALTH OF UKRAINE ZAPOROZHE STATE MEDICAL UNIVERSITY DEPARTMENT OF GENERAL PRACTICE – FAMILY MEDICINE EMERGENCY IN THE PRACTICE OF FAMILY DOCTOR THE TEXTBOOK FOR THE PRACTICAL CLASSES AND INDIVIDUAL WORK FOR 6TH-YEARS STUDENTS OF INTERNATIONAL FACULTY (SPECIALITY «GENERAL MEDICINE») DISCIPLINE: «GENERAL PRACTICE – FAMILY MEDICINE» Content module 3 Zaporozhye, 2015 Approved by: MoH of Ukrainе protocol № 2, the 16.06.2015 y. Readers: Chuhrienko N.D. – Doctor of Medical Sciences, Professor of Family Medicine department, Dnepropetrovsk State Medical Academy MoH of Ukraine; Kuryata O.V. – Doctor of Medical Sciences, Professor, head of Hospital therapy № 1 and profpathology department, Dnepropetrovsk State Medical Academy MoH of Ukraine. Writers: Mykhailovska N.S. – Doctor of Medical Sciences, Professor, head of General practice – family medicine department, Zaporozhye State Medical University; Grytsay A.V. – PhD, associate professor of General practice – family medicine department, Zaporozhye State Medical University. Methodical recommendations compiled in accordance with the program of «General practice - family medicine». Guidelines are intended to help students prepare for practical classes and learn the material. Can be used for training of 6th-years students of international faculty, discipline «General practice - family medicine». Zaporozhye state medical university Publishing office of ZSMU 2 CONTENT The thematic plan of practical classes…………………………………………….. 5 The thematic plan of independent work of student………………………………. 7 TOPIC 5. The emergency in the practice of family doctor. The emergency in the pre-hospital stage in the case of cardiac arrest, acute coronary syndrome, respiratory standstill, arrhythmias, hypertensic crisis, bronchoobstructive syndrome…………………………………………...................................... 8 TOPIC 6. The emergency in the practice of family doctor in the case of pain syndrome. The clinical classification of pain. The mechanism of pain in incurable patient. The principles of treatment of chronic pain syndrome. The emergency in context of incurable diseases and imminent death………………………………………………………………………. 35 TOPIC 7. The emergency in the practice of family doctor in the case of seizure, syncope, coma in case of diabetes, acute hepatic failure, alcohol intoxication, renal insufficiency, narcotic abuse……………………….. 80 TOPIC 8. The emergency in the practice of family doctor in the case of bite, sting, electrical injury, drowning, frostbite and thermal injury…………………. 132 Recommended literature………………………………………………………….. 163 3 PREFACE The family doctor has to provide emergency in the case of different life-threatening conditions: cardiac arrest, respiratory standstill, bronchoobstructive syndrome, hypertensic crisis, and pain. The timely diagnostics and ability to provides emergency at the pre-admission stage by family doctor, during transportation of the patient prevents complications, improves the treatment outcomes. This textbook includes the general principles and algorithms of emergency in the practice of family doctor in the case of pain. The necessity of this textbook is conditioned by absence of such workbooks, which satisfy requirements of basic parts of academic discipline «General practice – family medicine». This textbook is recommended for 6th-years students of Institute of higher education III-IV level of accreditation, speciality 7.12010001 «General medicine», training line 1201 «Medicine» studying related topics, interns, general practitioners, other specialists. 4 THE THEMATIC PLAN OF PRACTICAL CLASSES Module 1: «The organizational aspects of the system of the primary health care in Ukraine, its role in the development and reforming of the Public health». Number № Topic of hours Content module 1. Modern approaches to the medico-social and organizational basis of a primary health care 1 The place of the family medicine in the structure of a healthcare system 7 and the principles of the family service. The organization of the FD’s work. The basis recording documentation of FD in medical institution. The role of information system in FD practice. The basis of information processing of out-patient clinic. Content module 2. Medico-social aspects of population‘s health - the basis of the preventive and curing medicine 2 Medico-social aspects of the population’s health. The medical 6 examination of the population, and rehabilitation in the family doctor’s practice. Medical insurance structure and family doctor activity. The models of medical insurance in the world. 3 3.1. The assessment of the risk factors of the main chronic non-epidemic 4 diseases and the preventive measures in case of the cardiovascular, bronchopulmonary, gastrointestinal diseases and some other common syndromes. A role of family doctor in popularization of healthy life style and prophylaxis. The dietotherapy. “The health school”. 3.2. The prophylaxis of AIDS. 2 4 4.1. The organization of out-of-hospital therapeutic help in case of the 2 most wide-spread diseases. The principles of medico-social expertise. The organization of the day hospital and home care. 4.2. The consultation in the context of HIV-infectious, voluntary testing. 2 4.3. The consultation in the context of incurable disease and imminent death. The organization of medical care for non-curable patients. The 2 principle of multidisciplinary approach to medical care of non-curable patients and their relatives. Nursing, the methods of palliative care of symptoms and syndromes. Content module 3. The emergency in the family doctor’s practice. 5 Number № Topic of hours 5 The emergency in the practice of family doctor. The emergency in the 6 pre-hospital stage in the case of cardiac arrest, acute coronary syndrome, respiratory standstill, arrhythmias, hypertensic crisis, bronchoobstructive syndrome. 6 6.1.The emergency in the practice of family doctor in the case of pain 4 syndrome. 6.2.The clinical classification of pain. The mechanism of pain in 2 incurable patient. The principles of treatment of chronic pain syndrome. The emergency in context of incurable diseases and imminent death. 7 The emergency in the practice of family doctor in the case of seizure, 6 syncope, coma in case of diabetes, acute hepatic failure, alcohol intoxication, renal insufficiency, narcotic abuse. 8 The emergency in the practice of family doctor in the case of bite, sting, 5 electrical injury, drowning, frostbite and thermal injury. Final module control. 2 TOTAL 50 6 THE THEMATIC PLAN OF INDEPENDENT WORK OF STUDENT Number № Тopic Control type of hours 1. Preparation to the practical classes, the academic 20 level and training of practical skills 2. The implementation and defense of the practical 4 tasks 3. Filling of the family doctor’s documentation 3 Current control 4. The preparation and writing of the program of 4 during practical treatment in out-patient in the case of most classes widespread diseases 5. Drew up the algorithms of the pre-admission 4 emergency in the family doctor’s practice 6. The report at a clinical conference of hospitals. 1 7. Preparation for the final module control 4 Final module control Total 40 7 TOPIC 5 The emergency in the practice of family doctor. The emergency in the pre- hospital stage in the case of cardiac arrest, acute coronary syndrome, respiratory standstill, arrhythmias, hypertensic crisis, bronchoobstructive syndrome. І. Theme actuality According to official data, sudden death cases are about 10% among all reasons of death. In developed countries every year dies suddenly a lot of people: in the U.S. – 330 000, in Russia -300 000 persons. According to U.S. statistics, 250 000 cases of sudden death occurring at home, at work, in urban centers and only 80 000 cases - in hospitals. It was found that leading cause of sudden death is ventricular fibrillation. ІІ. Study purposes: to know clinical presentations of sudden death and the first aid on the pre-admission stage. ІІІ. Concrete purposes of the module: To know the organization and content of out-patient clinic; To identify diseases that require emergency care; To be able to assess the state of patient and provide appropriate medical care in the case of major syndromes which requiring urgent medical assistance of family doctor; To be able to perform cardiopulmonary resuscitation: the restoration of patency of airways, to correct arrhythmias, defibrillation. IV. A student must be able: To know the basic diseases that may complicate the development of sudden death; To know the principles of restoration of passable respiratory tract; To know the technique of closed-chest cardiac massage; To explain the mechanism of respiration; To know the algorithm of defibrillation. V. Task for initial independent training 1. At the first defibrillation attempt in adult the electric discharge is: A. 400 J B. 250 J C. 200 J D. 360 J E. 300 J 8 2. The most effective method of urgent ventilation is: A. Rhythmical chest compression B. mouth-to-mouth method C. Sylvester’s method D. Holger-Nielsen’s method E. Ambu’s bag 3. After a primary cardiac arrest consciousness disappears through: А. 10-15 sec B. 2 min. C. 15-20 sec D. 1 min. E. 30 sec 4. The most common cause of sudden death is: A. Hypertensive crisis B. central nervous system lesion C. Acute hemorrhage D. Disease of cardiovascular system E. Cancer 5. What is the primary symptom for diagnose the circulatory arrest? A. Convulsion B. Absence of heart sounds by auscultation C. Absence of carotid pulsation D. midriatic pupils E. Absence of spontaneous